Test 2 Flashcards

(114 cards)

1
Q

What is the prevalence of any form of perio in the US?

A

80%-including gingivitis

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2
Q

What is the prevalence of chronic adult perio?

A

35%

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3
Q

What are the inflammatory cells?

A

Lymphocytes
Polymorphonuclear leukocytes (PMN’s)
Macrophages

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4
Q

What is chemotaxis?

A

Process which attracts inflammatory cells to areas of the body by stimuli such as trauma and microbial presence

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5
Q

What are cytokines?

A

Substances produced by stimulated immune cells

Stimulate release of the inflammatory cells

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6
Q

What is mechanical treatment?

A

Root debridement

Effective but 10-20% of bacteria still remain within the sulcus after treatment

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7
Q

What are types of adjunctive chemical therapies?

A

Systemic and topical

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8
Q

Systemic Antibiotic Therapy

A

Aggressive perio
Perio that does not respond to treatment
Perio abscess

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9
Q

Disadvantages of systemic antibiotic therapy

A

allergic reactions
bacterial resistance
contraindication-pregnant, nursing, birth control

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10
Q

What is the drug of choice for systemic antibiotic?

A

Tetracycline
Stays highly concentrated in crevicular fluid
-careful with this due to photosensitivity

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11
Q

What is enzyme suppression therapy?

A

Periostat
Low dose systemically delivered antibiotic
Doxycycline 20 mg 2xd
9-12 months
Sub antimicrobial dose produces enzyme inhibition
*inhibits collagenase from activating inflammatory response

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12
Q

what is local antimicrobial therapy?

A

placement of antibiotic or antimicrobial agent at a periodontal site
very concentrated

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13
Q

What is substantivity?

A

ability of an agent to be bound to the pellicle and tooth surface.
Released over an extended period of time
retention of potency

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14
Q

Perio Chip

A

Chlorhexidine
biodegradable gelatin mix
40% of drug released in 24 hours
difficult to place

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15
Q

Atridox

A

10% doxycycline hylcate
two syringes-mix
can pack with instrument
tx time: 7-10 days
can use the whole syringe for multiple sites
leaves behind fiber-bring pt back 2 weeks later to remove

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16
Q

Arestin

A
Minocycline hydrochloride 1 mg
polymer microspheres in powder form
attaches to tooth and sulcus wall
antimicrobial
tx time: 14 days
easy to apply
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17
Q

Advantages of local antimicrobial therapy

A

concentration up to 100 times higher than systemic
minimal or no systemic involvement
delivered where needed
prolonged release over time

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18
Q

When do we utilize local periodontal medicaments?

A

initial non-surgical therapy
reveal appointment
non-responsive site

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19
Q

What are three types of fulcrums?

A

Intraoral
Extraoral
Advanced

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20
Q

What are some elements of an extra oral fulcrum?

A

broad surface area contact between hand and patients face
extended grasp of instrument
appropriate pressure into skin

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21
Q

Advantages of extra oral fulcrum?

A

access to deep pockets
access to maxillary molars
neutral wrist position

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22
Q

Disadvantages of extra oral fulcrum?

A

operator may feel unstable

decreased strength

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23
Q

T/F: Extra oral fulcrums decrease control.

A

FALSE

Control is dependent on the fulcrum pressure

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24
Q

What is an advanced fulcrum?

A

Variations of both intramural and extra oral fulcrums to gain access to deep pockets

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25
Disadvantages of advanced fulcrum?
Requires greater amount of muscle coordination and instrumentation skills greater chance of instrument stick
26
Split fulcrum
weak fulcrum finger action rather than wrist action does not allow for deep access into pockets
27
What is oral irrigation
The targeted application of water or other irrigation fluid for preventative or therapeutic use
28
Advantages of patient applied irrigation
Removal of loosely attached biofilm | special needs areas -bridges, implants, ortho
29
Disadvantages of patient applied irrigation
possible dexterity issues limited reach sub possibility of tissue trauma patient compliance
30
Uses of professionally delivered irrigation
post root debridement during non surgical perio therapy during perio maint appt acute periodontal infections
31
What are some agents used for irrigation?
``` CHX Water Stannous Fluoride Listerine Herbal solutions ```
32
Uses of mouthrinses
``` pretreatment biofilm control reduce inflammation caries prevention remineralize ```
33
Stannous Fluoride
F ion depositedo n enamel/carious lesion | Tin ion interferes with cell metabolism/antimicrobial effect
34
Sodium Fluoride
Deposits F ion on the enamel/carious lesion
35
Chlorhexidine
``` Broad spectrum antibacterial binds to hard and soft tissues released over time causes cell lysis 8-12 hour substantivity ```
36
Phenolic related essential oils-Listerine
Thymol, eucalyptol, menthol disrupts cell wall, inhibits bacterial enzymes decreases biofilm effects low substantivity
37
Cetylpyridinium Chloride CPC
rupture cell wall decreases ability of bacteria to attach to pellicle poor substantivity
38
Oxygenating agents
alters cell membrane, increases permeability release of oxygen helps to debride area questionable efficacy poor substantivity
39
What is Xerostomia?
patients perception of oral dryness 1 in 4 increases to 40% in people over 55 years
40
What are some clinical signs of xerostomia?
``` inflammation/redness tissue tight and shiny secondary infections increase in caries halitosis painful, cracked lips coated, dry, shiny tongue ```
41
What is saliva made up of?
``` over 99% water buffering agents enzymes minerals electrolytes proteins ```
42
What are the functions of saliva?
``` Lubrication and protection Buffering and cleaning Maintaining tooth integrity Antibacterial action Taste and digestion ```
43
What is sialometry?
measurement of salivary flow rate below acceptable clinical levels
44
What are the normal salivary flow rates?
stimulated: 1-3 mL/minute unstimulated: .25-.35 mL/minute abnormal: anything below those
45
What is the healthy pH of saliva?
6.7-7.4
46
What is an abnormal pH of saliva?
5.5-4.5
47
How much saliva do we produce per day?
1-1.5 liters per day
48
What is dentinal hypersensitivity?
an exaggerated response to a sensory stimulus | 1 in 5
49
What are the clinical symptoms of dentinal hypersensitivity?
mild to extreme pain short, sharp pain thermal, evaporative, tactile, osmotic stimuli
50
What is the most common cause of dentinal hypersensitivity?
toothbrush abrasion!
51
What is Brannstrom's hydrodynamic theory?
Fluid flow in dentinal tubules disturbed by thermal, chemical, mechanical, & osmotic stimuli Fluid flow osmotic changes stimulate the nerve processes in the more pulpal portions of the dentin and dentin itself=pain
52
What are the desensitizing mechanisms?
``` nerve desensitization protein precipitating agents tubule occlusion/seal physical laser ```
53
How does potassium nitrate work?
penetrates through tubules to the nerve, keeps nerve from firing
54
How do protein precipitating agents work?
``` ions precipitate (group together to form blockage in tubules) F varnish ```
55
How does tubule occlusion work?
tubules are sealed over to prevent stimuli gluma bond/sealer ACP
56
What are physical mechanisms for desensitization?
connective tissue graft composite restoration Crown
57
How do lasers work?
fuses dentinal tubules | when used with fluoride effectiveness is increased
58
What is demineralization?
fermentable carbs get into plaque--bacteria in plaque use these to produce acid--the acids destroy minerals in the enamel
59
What is remineralization?
Calcium and phosphate ions penetrate into the enamel--crystals fill in the space left by demin.--pH of saliva becomes more neutral
60
What is ACP?
Amorphous Calcium Phosphate combines soluble calcium and phosphorus salts Arm&Hammer tp Enamel Pro
61
What is recaldent?
stabilizes the calcium phosphate and increase the level in dental plaque and saliva casien=byproduct of milk MI paste
62
What is novamin?
bioactive glass, compound made of calcium, phosphate, silica and sodium claims to relieve sensitivity and provide rapid remineralization NUPRO
63
What is Pro-Arginine?
Colgate sensitive relief occludes tubules applied in office with rubber cup
64
What is osteonecrosis?
necrosis of the bone due to an obstruction of the blood supply
65
Osteonecrosis of the jaw ONJ can occur because:
``` radiation therapy chronic corticosteriod therapy immunocompromised patients uncontrolled infections major trauma ```
66
What are bisphosphonates?
class of drug used in the treatment of bone diseases affects bone metabolism they bind to the bone surface and are ingested by osteoclasts, osteoclastic function is slowed new bone made faster than it can be resorbed
67
What are some diseases most commonly associated with bisphosphonate use?
``` osteoporosis metastatic bone disease pager's disease hypercalcemia breaste and prostate cancers ```
68
Is it more likely to develop ONJ when taking bisphosphonates orally or IV?
IV | greater the length of time using bisphosphonates the greater the risk
69
What are some symptoms of ONJ?
``` non healing extraction sites exposed jaw bone radiographically large areas of radiolucency pain in jaw with no trauma mobility of teeth ```
70
What are the oral bisphosphonates?
Fosamax Boniva Actonel
71
What are the IV bisphosphonates?
Reclast-1xyear Aredia Zometa
72
What are methamphetamines?
CNS stimulant which acts on the brain causes increased release of neurotransmitters euphora weight loss
73
Where is decay found in a meth mouth?
anterior ipx | posterior cervical buccal and lingual
74
How does meth work?
induces high faster than cocaine-absorbed quicker high lasts longer than cocaine high is more intense
75
What are the immediate effects of meth?
intense state of euphoria up to 12 hours increase wakefulness rapid heart rate dilated pupils
76
What is formication?
most common visual effect of long term meth use skin lesions meth mites result of excessive scratching or picking
77
What are some long term effects of meth?
``` stroke, increase BP and heart rate violent behavior confusion paranoia delusions ```
78
What are the dental effects of meth?
``` rampant caries gingivitis/perio xerostomia bruxing tmj symptoms tooth fractures ```
79
What is the #1 reason for rampant caries?
lack of home care | drink of choice is mountain dew
80
What are some effects of oral piercings on oral tissues?
``` decalcification recession malodor caries abrasion allergic reactions ```
81
What can we recommend to patients with oral piercings?
``` remove frequently thorough dental assessments regular dental visits removable over fixed clean daily good oral hygiene habits fluoride paste or gel ```
82
What are the initial dental impacts of oral piercings?
``` initial inflammation hemorrhage asphyxiation of jewelry nerve damage communicable disease trauma infections altered speech ```
83
What teeth are most likely to be broken with oral piercings?
maxillary premolars
84
What can we instruct our patients with oral piercings to do if they have problems?
daily, mild non-iodized sea salt rinses 4-5 times a day | removal of jewelry
85
Factors contributing to oral cancer
``` quantity and frequency of tobacco use quantity and frequency of alcohol consumption tobacco and alcohol combined genetic tendency sun exposure HPV ```
86
Tissue changes that may indicate oral cancer
``` white lesions-filmy to thick red velvety lesions indurated growths in a white lesion papillary masses brown/black pigmented areas ```
87
What are the symptoms of oral cancer?
ulcerations that bleed easily and or not resolve within 2 weeks persistant pain, parasthesia bleeding
88
High risk sites for oral cancer
``` lower lip vermillion border tongue floor of mouth soft palate tonsillar pillars and palatine tonsils ```
89
What is dysplasia?
an abnormal growth of cells that begins in the epithelium can appear as white, red or mixed can often resolve if stimulus is removed
90
What is leukoplakia?
a white patch or plaque that cannot be scraped off
91
What is erythroplakia?
bright red lesions of the oral mucosa that cannot be characterized as any specific disease more of a concern than leukoplakia
92
What is a degree 1 lesion?
slight superficial wrinkling pale white or gray no thickening and lesions may disappear when stretched
93
What is a degree 2 lesion?
distinct white gray or red color changes wrinkling is obvious mucosa is not thickened color change remains when mucosa is stretched
94
What is a degree 3 lesion?
white or grayish color deep furrows thickening of the mucosa lesions persist when tissue is stretched
95
What is basal cell?
``` common in areas exposed to the sun open, bleeding crusted lesions red, raised or itchy shiny, pink, red, white, or translucent nodules that don't resolve crusted craters ```
96
What is squamous cell?
most common open, painless lesions that do not resolve in 2 weeks wart-like persistent, scaly red patches with irregular borders may bleed easily rough surfaces and central depression
97
What is melanoma?
very often fatal develop near or from mole ABC's
98
What are the ABC's for melanoma?
``` Asymmetry border color diameter evolving ```
99
HPV
most common STD leading cause of oral pharyngeal cancers HPV 16 and 18 back of the mouth
100
What are some side effects of cancer therapy?
``` oral mucositis xerostomia caries candidiasis trismus osteonecrosis ```
101
What is an impairment?
an abnormality of structure or function of a limb or body organ
102
What is a disability?
the inability to perform a task or activity as a result of the impairment
103
What is a handicap?
disadvantage or limitation that an individual has when compared with others of the same sex, age, background that has resulted from the impairment or disability
104
T/F: disabilities are always permanent
false
105
T/F: restraint requires consent from parent or guardian
True
106
What is protective stabilization?
any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body or head
107
What is active immobilization?
restraint by another person
108
What is passive immobilization?
utilizes a restraining device
109
What are supportive straps?
placed on wrists and ankles tied to chair
110
What is a pediwrap?
nylon mesh that encloses the patient from neck to ankles
111
What is a papoose board?
board with padded wraps to enclose a patient
112
What are some chemical restraints?
``` xanax adavan versed prpofol valium halcion ```
113
What are some adjunctive therapies for special needs patients?
``` xylitol products fluoride products fluoridated water reduction of fermentable carbs chx rinse ```
114
What are the guidelines for informed consent?
``` nature of oral disease condition reason for recommended care alternatives consequences potential complications ```